Practice Forms
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Patient Registration Form New Patient Registration Information |
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HIPPA Form |
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HIPPA Form Privacy Practice |
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Privacy Practice Including Informed Consent for Telehealth Services |
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STS Application Form |
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Office Fees |
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Parking Permit Application Handicap Parking Permit Application |
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Chronic Care Management (CCM) Consent Spanish Chronic Care Management (CCM) Consent Spanish |
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Chronic Care Management (CCM) Consent English Chronic Care Management (CCM) Consent English |
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Chronic Care Management Program Description We are proud to introduce our Preventative Wellness program for our Medicare patients. Effective October 1, 2018, we are urging all eligible Medicare patients to enroll into our Chronic Care Management program with our program Care Coordinator. |